Inductively coupled plasma mass spectrometry (ICP-MS) was applied to determine the concentrations of lead (Pb), cadmium (Cd) and arsenic (As) in Lindera aggregata (Sims) Kosterm. The physiologically based extraction test (PBET) digestion in vitro/Caco-2 cell model was established to investigate the bioaccessible contents of Pb, Cd and As in decoction of Lindera aggregata (Sims) Kosterm. The target-organ toxicity dose modification of HI method (TTD) was used to evaluate the cumulative risk caused by the combined exposure of the total levels of Pb, Cd and As in Lindera aggregata (Sims) Kosterm. and the bioaccessible contents in the decoction. The results showed that the total contents of Pb, Cd and As in 4 batches of samples were in the range of 2.901-3.872, 1.299-1.800 and 0.062-0.216 mg·kg^-1, respectively. After transportation by Cacco-2 cells, the bioaccessible contents of Pb, Cd, and As in the decoction were in the range of 0.045-0.080, 0.070-0.112 and 0.004-0.018 mg·kg^-1. The results of risk assessment showed that calculated by the total amounts of heavy metals in the Lindera aggregata (Sims) Kosterm., for the end points of nervous system, the cumulative risks of co-exposure of heavy metals in 3 batches of samples were of concern. After decoction and transportation by Caco-2 cells, for the end points of cardiovascular system, blood, nervous system, kidney and testis, the TTD modification of HI values of all batches of samples were less than 1, and the health risks were acceptable. The study provided methodology basis for a more objective assessment of the health risks of heavy metals and harmful elements in traditional Chinese medicine and for a more scientific limit standard of heavy metals and harmful elements.

Objective: To investigate the surgical indications and perioperative clinical outcomes of pelvic exenteration (PE) for locally advanced, recurrent pelvic malignancies and complex pelvic fistulas. Methods: This was a descriptive study.The indications for performing PE were: (1) locally advanced, recurrent pelvic malignancy or complex pelvic fistula diagnosed preoperatively by imaging and pathological examination of a biopsy; (2)preoperative agreement by a multi-disciplinary team that non-surgical and conventional surgical treatment had failed and PE was required; and (3) findings on intraoperative exploration confirming this conclusion.Contraindications to this surgical procedure comprised cardiac and respiratory dysfunction, poor nutritional status,and mental state too poor to tolerate the procedure.Clinical data of 141 patients who met the above criteria, had undergone PE in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to September 2022, had complete perioperative clinical data, and had given written informed consent to the procedure were collected,and the operation,relevant perioperative variables, postoperative pathological findings (curative resection), and early postoperative complications were analyzed. Results: Of the 141 included patients, 43 (30.5%) had primary malignancies, 61 (43.3%) recurrent malignancies, 28 (19.9%) complex fistulas after radical resection of malignancies,and nine (6.4%)complex fistulas caused by benign disease. There were 79 cases (56.0%) of gastrointestinal tumors, 30 cases (21.3%) of reproductive tumors, 16 cases (11.3%) of urinary tumors, and 7 cases (5.0%) of other tumors such mesenchymal tissue tumors. Among the 104 patients with primary and recurrent malignancies, 15 patients with severe complications of pelvic perineum of advanced tumors were planned to undergo palliative PE surgery for symptom relief after preoperative assessment of multidisciplinary team; the other 89 patients were evaluated for radical PE surgery. All surgeries were successfully completed. Total PE was performed on 73 patients (51.8%),anterior PE on 22 (15.6%),and posterior PE in 46 (32.6%). The median operative time was 576 (453,679) minutes, median intraoperative blood loss 500 (200, 1 200) ml, and median hospital stay 17 (13.0,30.5)days.There were no intraoperative deaths. Of the 89 patients evaluated for radical PE surgery, the radical R0 resection was achieved in 64 (71.9%) of them, R1 resection in 23 (25.8%), and R2 resection in two (2.2%). One or more postoperative complications occurred in 85 cases (60.3%), 32 (22.7%)of which were Clavien-Dindo grade III and above.One patient (0.7%)died during the perioperative period. Conclusion: PE is a valid option for treating locally advanced or recurrent pelvic malignancies and complex pelvic fistulas.
Humans ; Pelvic Exenteration/methods* ; Pelvic Neoplasms/surgery* ; Retrospective Studies ; Neoplasm Recurrence, Local/surgery* ; Postoperative Complications

OBJECTIVE: To compare the operation complexity and accuracy of traditional splint impression technique and impression technique with prefabricated rigid connecting bar system for full-arch implants-supported fixed protheses in vitro. METHODS: Standard mandibular edentulous model with six implant analogs was prepared. The implants were placed at the bone level and multiunit abutments screwed into the implants. Two impression techniques were performed: the traditional splint impression technique was used in the control group, and the rigid connecting bar system was used in the test group. In the control group, impression copings were screwed into the multiunit abutments and connected with autopolymerizing acrylic resin. Open tray impression was fabricated with custom tray and polyether. In the test group, cylinders were screwed into the multiunit abutments. Prefabricated rigid bars with suitable length were selected and connected to the cylinders with small amount of autopolymerizing acrylic resin, and open tray impression was obtained. Impression procedures were repeated 6 times in each group. The working time of the two impression methods were recorded and compared. Analogs were screws into the impressions and gypsum casts were poured. The gypsum casts and the standard model were transferred to stereolithography (STL) files with model scanner. Comparative analysis of the STL files of the gypsum casts and the standard model was carried out and the root mean square (RMS) error value of the gypsum casts of the control and test groups compared with the standard model was recorded. The trueness of the two impression techniques was compared. RESULTS: The work time in the test group was significantly lower than that in the control group and the difference was statistically significant [(984.5±63.3) s vs. (1 478.3±156.2) s, P < 0.05]. Compared with the standard model, the RMS error value of the implant abutments in the test group was (16.9±5.5) μm. The RMS value in the control group was (20.2±8.0) μm. The difference between the two groups was not significant (P>0.05). CONCLUSION The prefabricated rigid connecting bar can save the chair-side work time in implants immediate loading of edentulous jaw and simplify the impression process. The impression accuracy is not significantly different from the traditional impression technology. The impression technique with prefabricated rigid connecting bar system is worthy of clinical application.
Acrylic Resins ; Calcium Sulfate ; Dental Implants ; Dental Impression Materials ; Dental Impression Technique ; Humans ; Jaw, Edentulous ; Models, Dental ; Mouth, Edentulous

ObjectiveThe purpose of this study is to analyze the intraoperative and postoperative conditions of pediatric laparoscopy in fertility preservation in pubertal and prepubertal patients with β-thalassemia major （TM） and to further explore the prospects of pediatric laparoscopy in fertility preservation surgery. MethodsTotally 13 pubertal and prepubertal patients with β-TM who underwent ovarian tissue cryopreservation （OTC） combined with in vitro maturation （IVM） for fertility preservation through pediatric laparoscopic acquisition of ovarian tissue before hematopoietic stem cell transplantation were analyzed. ResultsAll 13 children underwent laparoscopic unilateral oophorectomy， with an average operative time of （58.31±20.25） minutes and an average intraoperative bleeding of （2.46±1.13） mL. All 13 children had no postoperative complications and an average hospital stay of （3.62±1.33） days. All children had ovarian tissue available for cryopreservation； the average pieces of ovarian tissue frozen was 7.77±2.31. Eleven of them also had mature oocytes available for cryopreservation； the average number of oocytes frozen was 4.92±4.27. ConclusionPediatric laparoscopic is a safe and effective fertility-preserving procedure that can be strongly promoted in pubertal and prepubertal patients with β-TM.

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.
3-Oxo-5-alpha-Steroid 4-Dehydrogenase/genetics* ; Child ; China/epidemiology* ; Cryptorchidism/genetics* ; Disorders of Sex Development/genetics* ; Female ; Genital Diseases, Male ; Genotype ; Humans ; Hypospadias/genetics* ; Male ; Membrane Proteins/genetics* ; Penis/abnormalities* ; Phenotype ; Retrospective Studies ; Steroid 21-Hydroxylase/genetics*

OBJECTIVE: To evaluate the characteristics of autoimmune hemolytic anemia caused by salvianolate by antibody detection and clinical index monitoring. METHODS: Micro-column gel anti-human globulin method was used for irregular antibody screening and antibody identification. Salvianolate, sodium creatine phosphate and levocarnitine were used to sensitize red blood cells that were compatible with the patient's plasma, and the RBCs were used to test drug antibody in patient plasma respectively. The patient's clinical examination of hemolysis index and blood transfusion effect were analyed retrospectively. RESULTS: The patients were positive for irregular antibody screening, and there were antoanti-Ce antibodies in serum. The erythrocytes sensitized with salvianolate in the patient's serum were positive, while those sensitized with sodium creatine phosphate and levocarnitine were negative. CONCLUSION Salvianolate causes drug-induced autoimmune hemolytic anemia in this patient.
Anemia, Hemolytic, Autoimmune ; Blood Transfusion ; Erythrocytes ; Humans ; Plant Extracts ; Retrospective Studies

Objective To establish a HPLC-MS/MS method for simultaneous determination of the concentration of simvastatin, simvastatin acid and rivaroxaban in rats plasma. Methods The plasma samples were determined after secondary extraction with ethyl acetate. Ticagrelor and lovastatin were used as internal standards. Simvastatin, simvastatin acid and rivaroxaban in rats plasma were separated by Waters C18 (150. 0 mm × 4. 6 mm, 3. 5 μm) with mobile phase consisting of acetonitrile?ammonium (75: 25, pH = 4. 5) . Electrospray ionization source was applied and operated in positive multiple reaction monitoring mode. Polarlity switch (negative-positive mode) was performed. The detector was operated in multiple reaction-monitoring mode at m/z 436. 0→144. 9 for simvastatin, m/z 452. 9 → 162. 3 for simvastatin acid, m/z 324. 1 →127. 2 for rivaroxaban, m/z 521. 1→361. 2 for Ticagrelor and m/z 405. 3→199. 0 for lovastatin. The specificity, standard curve and lower limit ofquantification, precision and recovery, stability and matrix effect of the method were investigated. Results The linear ranges of simvastatin, simvastatin acid and rivastatin in plasma were 1-100, 5-400 and 1-100 ng·m L-1, standard curve were y = 0. 78 x + 7. 00 × 10-4 (r = 0. 992 8) , y = 0. 59 x + 2. 57 × 10-2 (r = 0. 997 2) and y = 1. 09 x + 1. 79 ×10-2 (r = 0. 996 4) , and the lower limit of quantitation were 1, 5 and 1 ng·m L-1, respectively. The intra-day and inter-day standard deviation were less than 15％, and the recovery rate reached more than 70％. The plasma samples had a good stability with freezing-thawing for three times, -80 ℃ for 5 days and 4 ℃ for 24 h. And there was no obvious matrix effect. Conclusion The method was simple, specific and sensitive, suitable to detect a number of samples for pharmacokinetic study.

ObjectiveTo investigate the value of micro- dissection testicular sperm extraction (micro-TESE) in the treatment of non-obstructive azoospermia (NOA) in patients with the history of secondary testicular injury.

METHODSTotally, 121 NOA patients with the history of secondary testicular injury underwent micro-TESE in our hospital from September 2014 to December 2017. We analyzed the correlation of the sperm retrieval rate with the causes of testicular injury and compared the outcomes of the ICSI cycles with the sperm retrieved from the NOA males by micro-TESE (the micro-TESE group) and those with the sperm ejaculated from severe oligospermia patients (sperm concentration <1×10⁶/ml, the ejaculate group). Comparisons were also made between the two groups in the female age, two-pronucleus (2PN) fertilization rate, transferrable embryos on day 3 (D3), D3 high- quality embryos, D14 blood HCG positive rate, embryo implantation rate, and clinical pregnancy rate.

RESULTSTesticular sperm were successfully retrieved by micro-TESE in 86.0% of the patients (104/121), of whom 98.4% had the history of orchitis, 75.5% had been treated surgically for cryptorchidism, and 63.6% had received chemo- or radiotherapy. No statistically significant differences were observed between the micro-TESE and ejaculate groups in the 2PN fertilization rate (59.4% vs 69.3%, P > 0.05), D14 blood HCG positive rate (44.6% vs 57.9%, P > 0.05), embryo implantation rate (31.8 %% vs 32.6%, P > 0.05) and clinical pregnancy rate (41.5% vs 48.7%, P > 0.05). However, the rate D3 transferrable embryos was significantly lower in the micro-TESE than in the ejaculate group (40.5% vs 52.2%,P < 0.05), and so was that of D3 high-quality embryos (32.5% vs 42.1%, P < 0.05).

CONCLUSIONSMicro-TESE can be applied as the first choice for NOA patients with the history of secondary testicular injury, but more effective strategies are to be explored for the improvement of ICSI outcomes with the sperm retrieved by micro- TESE.

Objective: To evaluate the factors affecting the use of the POGS PNSS across institutions. Basic Procedure: A cross-sectional study was done by the POGS Committee on Nationwide Statistics from November 2017 to April 2018. Eight representative institutions were chosen from POGS accredited institutions for service and training from the NCR, Luzon, Visayas, and Mindanao, based on the classifications of I. Complete Data, II. Incomplete Data, III. Wrong Format, and IV. No Data. Hospitals with the most number of admissions under each category were chosen. Interviews with chairpersons of the departments, Focus Group Discussions (FGD) with the OB-GYN residents, and actual direct observations of how data were encoded in the PNSS were done. Results: All the chairpersons and Ob-Gyn residents of the selected institutions were aware of the importance of the PNSS especially in generating vital nationwide statistics like Maternal Mortality and Morbidity Rates. They had several pertinent suggestions on how improvement of the PNSS, like harmonization of classification of diseases with PHIC and ICD codes, and to include other co-morbidities in the system. Conclusion The factors affecting the use of POGS-PNSS in 2016 include: good attitude and compliance among POGSaccredited institutions, but there is a need to address multiple diagnosis including medical co-morbidities. Final diagnosis also needs to be PHIC-compliant, and there is a need to address the Data Privacy Act with the use of eMR (electronic medical records).
International Classification of Diseases ; Cross-Sectional Studies ; Morbidity